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Jaundice in the newborn

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Jaundice is a yellow discoloration of the skin and is seen to some extent in 50 percent of newborn infants. Given the frequency of its occurrence, is this a matter of concern for you as parents?

First, a little bit of basic biology: the cause of the yellow color is a chemical substance called bilirubin. It is produced as part of a normal physiologic process from the breakdown of red blood cells, which normally occurs after birth.

In the majority of full-term babies, the bilirubin level usually peaks on the third day of life, with no harmful effects, as it is processed by the liver and intestines.

However, in some cases, the bilirubin can reach such high levels that it crosses into the brain, causing damage that leads to long-term disabilities like cerebral palsy and deafness.

It is difficult to tell if a child suffers from “hyperbilir­ubinemia” by appearance alone and, in this era of early hospital discharge, many newborn infants are sent home before bilirubin reaching its peak value — so doctors and nurses can’t even check on them with their trained eyes.

On top of that, some patients can produce higher levels of bilirubin. An example of this is blood type mismatch between mothers and babies. This results in antibodies crossing the placenta to the baby before birth, causing the excessive destruction of red blood cells even after birth.

In addition, the number of late preterm infants has grown in recent years, and, despite their immature liver function — which is unable to meet the demand of increased bilirubin load after birth — are still discharged early because of their “near term” birth weights.

As more mothers breast-feed their newborn infants, we cannot lose sight of the importance of adequate education and support.

Unbeknownst to them, some of these mothers may be producing inadequate milk, resulting in impaired intestinal elimination of bilirubin.

With all of these converging factors, how can you successfully navigate your way toward safe management of your baby’s jaundice?

The American Academy of Pediatrics currently recommends that every newborn baby have a bilirubin measurement performed at 24 hours of age.

Although levels have traditionally been measured on blood samples, we at Staten Island University Hospital have begun to measure levels through the skin with a specialized device that is safe, painless, reliable, and able to produce nearly instant results.

The bilirubin level is then compared to a standardized chart to determine the “percentile,” which tells us the child’s risk.

Babies at higher risk require more frequent follow-up measurements, whether in the newborn nursery or following discharge.

When levels do exceed specific thresholds based on the infant’s age, in hours, the infant is placed under special blue lights called phototherapy, which alters the chemical structure of bilirubin, allowing it to be eliminated from the body. Fortunately, phototherapy works so well that a procedure called exchange transfusion, which lowers the bilirubin by exchanging the baby’s blood with fresh blood from the hospital blood bank, has virtually become a relic.

As a general rule, babies rarely get into clinical trouble if parents comply with all post-discharge appointments and scheduled bilirubin measurements.

Since jaundice generally progresses from head-to-toe, if your baby is yellow down to his thighs, make sure to alert your pediatrician. Remember that babies who are lethargic and don’t eat much are also showing signs of a high bilirubin level.

Beware — even if you are doing everything right, hyperbilirubinemia in need of phototherapy is the most common reason for re-admissions of newborn infants to the hospital. However, this does not occur often. So, if your baby is yellow, you can still be mellow — provided you are being attentive to follow up with your pediatrician and her staff.

Updated 4:29 pm, July 9, 2018
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